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Optimising recovery after surgery: Predictors of early discharge and hospital readmission
Author(s) -
Carter Jonathan,
Philp Shan,
Wan King M.
Publication year - 2016
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12484
Subject(s) - medicine , intensive care unit , adverse effect , laparotomy , incidence (geometry) , surgery , blood transfusion , body mass index , emergency medicine , physics , optics
Background Fast track surgery ( FTS ) programs minimise the stress response after surgery and allow for enhanced recovery. Aims To document the frequency and incidence of adverse events in patients enrolled on a FTS program and to investigate factors associated with shorter length of stay and readmission to hospital. Methods A seven‐year updated surgical audit of patients undergoing laparotomy for suspected or confirmed malignancy on a FTS program. Results Five hundred and fifty patients comprise the study group. Average age and body mass index (BMI) were 55 years and 28, respectively. Mean length of stay (LOS) was 3.4 days with 194 (35%) patients discharged on day 2. Six (1%) patients had confirmed venous thromboembolism ( VTE ), three of whom were diagnosed on pre‐operative imaging. Overall, transfusion rate was 5%. Adverse events in decreasing frequency were hospital readmission (4%) and significant wound infection (3%). All other adverse events were uncommon with rates <0.5%. Factors associated with a discharge on or after day 3 include age, pathology, Eastern Cooperative Oncology Group performance status, incision type, operating time, blood transfusion and cyclo‐oxygenase 2 inhibitors. Factors associated with hospital readmission include longer operating time, performance of lymph node sampling/dissection, longer LOS , development of wound infection, febrile morbidity, return to the operating room, unplanned intensive care unit admission and presence of other complications. Conclusions Patients managed by a FTS protocol can expect enhanced outcomes when compared to historical controls.